Four Common Types of Long-Term Disability Denials

For
those who suffer from a serious medical condition, such as a catastrophic
injury or a life-threatening illness, long-term disability insurance can be a
blessing – that is, if the insurance carrier pays when it is supposed to.
Sadly, many large disability insurance companies have a tendency to look for
clever ways to avoid paying otherwise perfectly valid claims. While this may
cut a few dollars off of the company’s bottom line each year, it can devastate
a deserving family who desperately depends on those funds for survival.

AtBurke Harvey, LLC, our long-term
disability insurance lawyers are here to make sure you and your family are
treated fairly and that you receive all of the money to which you are entitled.
Call us today to schedule a free consultation with one of our attorneys, and
let us review your situation to see if we can help.

Among
the many ways that insurance companies unfairly deny claims, here are just four
of the most common:

Making Partial Payments Instead of
Full Payments

A
long-term disability policy could arguably be called an income replacement
insurance policy. It is designed to replace a portion of your income while you
are out of work due to a qualifying condition. For instance, your policy may
provide for 70% of your regular salary, and it may have a 30-day waiting
period. This means you must first show that your medical condition is so
serious that it requires you to be out of work for more than 30 days, and such
a policy will then begin paying on Day 31.

This
is where some insurance carriers scam their policyholders. Some may start
making payments, then quickly cut payments to a lesser amount, based on
confusing or misleading policy provisions that reduce benefits. Other companies
may stop payments altogether, arguing that the medical condition did not meet
their guidelines, even after beginning payments. This can create a sort of
reliance, where the disabled individual starts depending on the benefits for
regular bills and support, only to have the benefits stripped months down the
road.

Not Disclosing Benefits

Many
states have outlawed the practice of concealing benefits from policyholders,
but insurance companies still do it. One of the oldest tricks in the insurance
company playbook is to outright mislead the consumers by not telling them the
whole truth about their coverages.

For
instance, you may have both a short-term and a long-term policy through your
employer. The long-term policy is, in most cases, designed to dovetail nicely
with the short-term policy so that the long-term coverage is triggered once the
short-term coverage runs out. This way there is no overlap or duplication in
payments. An insurance carrier may tell you that you have a lengthy waiting
period but fail to mention your rights under your short-term coverage, which is
often underwritten by the same company. Likewise, some carriers will also lie
about the amount of your benefits or what you must provide in order to obtain
your benefits.

Mislabeling Diagnoses

Perhaps
one of the most surreptitious maneuvers employed by the long-term disability
insurance industry is to mislabel or incorrectly characterize a medical
diagnosis in order to trigger an automatic denial.

Insurance
companies use diagnostic codes to properly outline and categorize the
assortment of potential health conditions that could make one eligible for
benefits. These diagnostic codes help insurance companies (and their computer
databases) sort out the difference between rotator cuff tendonitis and a
rotator cuff tear that requires surgery or a benign tumor from a
life-threatening one. By intentionally mislabeling a condition, an insurance
company can trigger a denial that deprives a deserving person of the benefits.

Technical Terminations and Delays

In
addition to all of these unscrupulous tactics, insurance companies also
frequently deploy simply bureaucracy as a strategic maneuver for avoiding
payment. By dragging their feet, they can leave people so hopeless that they
give up or miss appeal deadlines. This can lead to technical policy
terminations or technical denials.

What to do About
Improper Disability Insurance Denials in Alabama

It
is important to understand that both state and federal laws exist to protect
disabled workers and their rights to long-term disability insurance benefits.
After all, if you have one of these policies, it is because you have paid into
the program and purchased those benefits.

As
the Alabama Supreme Court held inNational Security Fire & Casualty Co. v. Bowen,
you may be able to bring a lawsuit against the insurance company for “bad
faith,” alleging that they intentionally or unreasonably denied your benefits.
To succeed, Alabama courts have held that you must prove:

There was a contract and the
insurance company breached it

The insurance company’s denial was
intentional

There was no reasonable basis for
the denial

The insurance company knew there was
no reasonable basis for the denial

If
you have been unreasonably or unfairly denied long-term disability benefits,
call the attorneys ofBurke Harvey, LLC today. We never
charge upfront fees or costs to get started, and we only get paid if we are
successful in recovering the benefits to which you are rightfully entitled. Socall us now to learn more or to
schedule a free case evaluation.

Does My
Condition Make Me Eligible for Long-Term Disability Insurance?

It
is not uncommon for someone dealing with a serious health concern to worry
about qualifying for disability benefits. Most people rarely give a second
thought to these things until they are actually faced with a severe medical
complication. Whether it is an unexpected injury or a deteriorating chronic
condition, the fact is that it is common to worry about how you will feed your
family, how you will keep your home or apartment, and how you will survive
without income.

This
then leads to a second and often troubling question: Does my condition qualify me for benefits? After all, just being
sick or injured does not necessarily entitle one to benefits from a long-term
insurance policy. As a preliminary matter, the best way to find out if your
particular diagnosis entitles you to benefits is to speak with a long-term
disability lawyer right here in Birmingham, Alabama.

AtBurke Harvey, LLC, our attorneys
have years of practical experience guiding disabled workers and their families
through some of the toughest times in their lives. If you are facing a
disability, give us a call today.

What is a Disabling Condition?

The
vast majority of long-term disability insurance policies are governed by the
federal law,ERISA (Employee Retirement Security
Act). That law generally gives insurance companies the right to define a
disabling condition contractually in the insurance policy. However, as a
general rule of thumb, a disabling condition is a mental, physical or emotional
condition that renders you unable to work. Likewise, in most cases, the
condition must be expected to last more than a year or be likely to cause your
death within two years or less.

Understanding How a Condition
Affects One’s Ability to Work

So,
what exactly does this mean for people who have chronic diseases or serious
injuries? Who exactly decides if you can work or not? This is the source of
much dispute. For instance, a person may have a bad back but still be able to
keep working in a sedentary office job, so long as the employer makes
reasonable accommodations for frequent breaks and there is no heavy lifting
involved. Even things like paralysis may not entirely make work impossible. It
all depends on the individual who is suffering from the condition.

This
is why long-term disability can get complicated. Consider the example of a
manual laborer who has spent 15 years in a trade. A serious back injury could
qualify the worker for long-term disability because his physician would likely
find that it is impossible for him to continue performing the set of skills and
tasks for which he is trained. Absent other job skills, a long-term disability
claim may be warranted.

Take
the same back injury for an office worker, and it may have very little impact
on his ability to keep working. Therefore, a disability claim may not be
warranted for that worker, even though both have the same medical diagnosis.

Medical Conditions That May Qualify
You for Long-Term Disability

According
to Social Security guidelines, you can find information about manymedical conditions online. Below
are some of the more common conditions that lead to long-term disability. Just
keep in mind that it is important to work with a physician who not only can
diagnose the problem, but who can also clarify why the condition impacts your
ability to work:

Anxiety disorders

Bipolar disorder

Panic attacks

Spinal injuries

Back injuries

Traumatic brain injuries

Various types of cancer

Cerebral palsy

Epilepsy and other seizure disorders

Heart conditions

HIV/AIDS

Leukemia

Obesity

Multiple sclerosis

Osteoarthritis

Parkinson’s disease

Post-traumatic stress disorder

Respiratory diseases

Stroke

Does a Long-Term Disability Policy
Use the Same Criterion as SSDI?

Not
necessarily, but they may be similar. The federal government sets forth the
rules for qualifying forSocial Security Disability (SSD).
While the insurance policies may at times mirror SSD guidelines, it is
important to understand that your long-term disability benefits are a private
insurance benefit payable under a contractual insurance policy. Therefore,
there are usually going to be distinct differences in how terms are defined and
how you must qualify.

One
thing both have in common is the need to prove your medical condition. It is
never enough to simply claim to have a medical condition or allege that it
keeps you from working. Instead, you will need competent and clear medical
evidence establishing not only your condition, but also demonstrating why that
condition directly limits your ability to pursue gainful employment. This is
often where a skilled long-term disability lawyer can be a tremendous asset.

Contact an Alabama Long-Term
Disability Lawyer Today

AtBurke Harvey, LLC, our attorneys
are devoted to helping obtain the benefits that you deserve. If your insurance
company has improperly denied your claim for benefits, we may even be able to
step in and help launch a rapid appeal. In other cases, we may need to sue your
insurance company to force them to honor their legal obligations. Just keep in
mind that time is limited, so you need to take action fast.Call our firm to discuss your case
right away.